Bill Text: IL HB0146 | 2021-2022 | 102nd General Assembly | Introduced

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Bill Title: Amends the Illinois Insurance Code and the Health Maintenance Organization Act. Provides that all individual and small group accident and health policies written in compliance with the Patient Protection and Affordable Care Act must file rates with the Department of Insurance for approval. Provides that rate increases found to be unreasonable rate increases in relation to benefits under the policy provided shall be disapproved. Requires the Department to provide a report to the General Assembly after January 1, 2023 regarding both on and off exchange individual and small group rates in the Illinois market. Requires that the Department approve or deny rate increases within 60 calendar days after the rate increase is filed with the Department. Provides that a rate increase that is not approved or denied by the Department on the 61st calendar day shall be automatically approved on that day. Provides that no less than 30 days after the federal Centers for Medicare and Medicaid Services has certified the plans described in this Section for the upcoming plan year, the Department shall publish on its website a report explaining the rates for the subsequent calendar year's certified policies. Defines "unreasonable rate increase".

Spectrum: Partisan Bill (Democrat 17-0)

Status: (Introduced - Dead) 2021-10-14 - Added Co-Sponsor Rep. Martin J. Moylan [HB0146 Detail]

Download: Illinois-2021-HB0146-Introduced.html

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102ND GENERAL ASSEMBLY State of Illinois 2021 and 2022 HB0146 Introduced , by Rep. Bob Morgan SYNOPSIS AS INTRODUCED:
215 ILCS 5/355 from Ch. 73, par. 967
215 ILCS 125/4-12 from Ch. 111 1/2, par. 1409.5
Amends the Illinois Insurance Code and the Health Maintenance Organization Act. Provides that all individual and small group accident and health policies written in compliance with the Patient Protection and Affordable Care Act must file rates with the Department of Insurance for approval. Provides that rate increases found to be unreasonable rate increases in relation to benefits under the policy provided shall be disapproved. Requires the Department to provide a report to the General Assembly after January 1, 2023 regarding both on and off exchange individual and small group rates in the Illinois market. Requires that the Department approve or deny rate increases within 60 calendar days after the rate increase is filed with the Department. Provides that a rate increase that is not approved or denied by the Department on the 61st calendar day shall be automatically approved on that day. Provides that no less than 30 days after the federal Centers for Medicare and Medicaid Services has certified the plans described in this Section for the upcoming plan year, the Department shall publish on its website a report explaining the rates for the subsequent calendar year's certified policies. Defines "unreasonable rate increase".
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A BILL FOR
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AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Insurance Code is amended by
changing Section 355 as follows:
(215 ILCS 5/355) (from Ch. 73, par. 967)
Sec. 355. Accident and health policies; provisions.
policies-Provisions.)
(a) As used in this Section, "unreasonable rate increase"
means a rate increase that the Director determines to be
excessive, unjustified, or unfairly discriminatory in
accordance with 45 CFR 154.205.
(b) No policy of insurance against loss or damage from the
sickness, or from the bodily injury or death of the insured by
accident shall be issued or delivered to any person in this
State until a copy of the form thereof and of the
classification of risks and the premium rates pertaining
thereto have been filed with the Director; nor shall it be so
issued or delivered until the Director shall have approved
such policy pursuant to the provisions of Section 143. If the
Director disapproves the policy form he shall make a written
decision stating the respects in which such form does not
comply with the requirements of law and shall deliver a copy

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thereof to the company and it shall be unlawful thereafter for
any such company to issue any policy in such form.
(c) All individual and small group accident and health
policies written in compliance with the Patient Protection and
Affordable Care Act must file rates with the Department for
approval. Rate increases found to be unreasonable rate
increases in relation to benefits under the policy provided
shall be disapproved. The Department shall provide a report to
the General Assembly on or after January 1, 2023, regarding
both on and off exchange individual and small group rates in
the Illinois market.
(d) A rate increase filed under this Section must be
approved or denied within 60 calendar days after the date the
rate increase is filed with the Department. Any rate increase
that is not approved or denied by the Department shall
automatically be approved on the 61st calendar day.
(e) No less than 30 days after the federal Centers for
Medicare and Medicaid Services has certified the policies
described in this Section for the upcoming plan year, the
Department shall publish on its website a report explaining
the rates for the subsequent calendar year's certified
policies.
(Source: P.A. 79-777.)
Section 10. The Health Maintenance Organization Act is
amended by changing Section 4-12 as follows:

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(215 ILCS 125/4-12) (from Ch. 111 1/2, par. 1409.5)
Sec. 4-12. Changes in Rate Methodology and Benefits,
Material Modifications. A health maintenance organization
shall file with the Director, prior to use, a notice of any
change in rate methodology, or benefits and of any material
modification of any matter or document furnished pursuant to
Section 2-1, together with such supporting documents as are
necessary to fully explain the change or modification.
(a) Contract modifications described in subsections
(c)(5), (c)(6) and (c)(7) of Section 2-1 shall include all
form agreements between the organization and enrollees,
providers, administrators of services and insurers of health
maintenance organizations.
(b) Material transactions or series of transactions other
than those described in subsection (a) of this Section, the
total annual value of which exceeds the greater of $100,000 or
5% of net earned subscription revenue for the most current
twelve month period as determined from filed financial
statements.
(c) Any agreement between the organization and an insurer
shall be subject to the provisions of the laws of this State
regarding reinsurance as provided in Article XI of the
Illinois Insurance Code. All reinsurance agreements must be
filed. Approval of the Director is required for all agreements
except the following: individual stop loss, aggregate excess,

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hospitalization benefits or out-of-area of the participating
providers unless 20% or more of the organization's total risk
is reinsured, in which case all reinsurance agreements require
approval.
(d) All individual and small group accident and health
policies written in compliance with the Patient Protection and
Affordable Care Act must file rates with the Department for
approval. Rate increases found to be unreasonable rate
increases in relation to benefits under the policy provided
shall be disapproved. The Department shall provide a report to
the General Assembly on or after January 1, 2023, regarding
both on and off exchange individual and small group rates in
the Illinois market.
(e) A rate increase filed under this Section must be
approved or denied within 60 calendar days after the date the
rate increase is filed with the Department. Any rate increase
that is not approved or denied by the Department shall
automatically be approved on the 61st calendar day.
(f) No less than 30 days after the federal Centers for
Medicare and Medicaid Services has certified the policies
described in this Section for the upcoming plan year, the
Department shall publish on its website a report explaining
the rates for the subsequent calendar year's certified
policies.
(g) As used in this Section, "unreasonable rate increase"
means a rate increase that the Director determines to be

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excessive, unjustified, or unfairly discriminatory in
accordance with 45 CFR 154.205.
(Source: P.A. 86-620.)